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All Caps=Recommended
Mario is the star of the many games that bear his name. He is probably the most recognized video game character in the world. He is depicted as a well-rounded individual who enjoys going on walks, painting, playing golf, composing music, playing tennis, driving go-karts, refereeing boxing matches, and many more activities. He has a brother who he often associates with, and he appears to have been in a long-term relationship with a woman named Peach. His employment is apparently a plumber, but he is not often found engaging in this activity. Mario also spends considerable time attempting to rescue Peach from his nemesis, Bowser. In order to reach this goal, Mario engages in a wide variety of behavior, including jumping on others, punching others, and even throwing fire. He also acquires (and possibly ingests) substances which appear to aid him, including mushrooms and flowers.
It should be noted that I have not interviewed Mario in person. However, after examining many hours of data provided over many years by multiple sources, my diagnosis can be made with a reasonable degree of confidence.
My initial diagnostic impressions include:
CONDUCT DISORDER
The essential feature of Conduct Disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. I will italicize statements that appear relevant to Mario.
Diagnostic Criteria:
A: A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:
Aggression to people and animals
(1) often bullies, threatens or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife, gun)
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g. mugging, purse snatching, extortion)
(7) has forced someone into sexual activity
Destruction of property
(8) has deliberately engaged in fire setting with the intention of causing serious damage
(9) has deliberately destroyed others’ property (other than by fire setting)
Deceitfulness or theft
(10) has broken into someone else’s house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations (i.e. “cons” others)
(12) has stolen items of nontrivial value without confronting a victim (e.g. shoplifting, but without breaking and entering; forgery)
Serious violation of rules
(13) often stays out at night despite parental prohibitions, beginning before age 13 years
(14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
(15) is often truant from school, beginning before age 13 years
B: The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
C: If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.
Analysis of Criteria
As indicated by the italicized entries above, Mario manifests many of the criteria of Conduct Disorder, He has initiated countless physical fights with others, both by jumping on top of them, punching them, or firing projectiles at them (criteria A2 and A3). He has been physically cruel to animals, most prominently a species of mushroom-like fungi known as a "goombas," and turtle-like creatures known as "koopas" (criteria A5). He has also harmed a variety of other creatures such as fish, squid, bees, and all manner of unusual animals, such as a ball with teeth tethered with a chain. He has taken keys, mushrooms, flowers, music boxes, stars, and other items following physical confrontations (criteria A6). He has damaged others' property, both by starting fires and by engaging in a very unusual form of vandalism whereby he will destroy segments of property by jumping up into it and damaging brickwork both with his hand and head (criteria A8, A9, and A10). He has also engaged in a wide variety of other destructive behavior, such as flooding domiciles and, initially, smashing barrels with a large mallet. His behavior appears to be causing significant impairment in social functioning; it appears likely his girlfriend Peach is continually kidnapped in retaliation for his behavior (criteria B).
Much of this activity appears to happen in a relatively short time period - that is, Mario will engage in a wide variety of activities such as golf and racing go-karts where he does not engage in these activities, but then at other times he will roam his neighborhood engaging in these activities non-stop. This behavioral pattern may be indicative of a manic episode. However, other symptoms of mania, such as grandiosity and higher energy levels, are not present. Much of his behavior may be described by a diagnosis of Antisocial Personality Disorder. However, Mario engages in many activities that are beneficial to others (such as rescuing kidnap victims), and this type of behavior is very atypical of Antisocial Personality Disorder (criteria C). His symptoms are also of significant seriousness to exclude a diagnosis of Oppositional Defiant Disorder.
It is possible that Mario's behavior may be explained by cultural or circumstantial factors. For example, his culture is markedly different from that of most Western civilizations and thus taking his behavior at face value is inappropriate. His behavior can be best understood by examining other's in his culture. By this measure, Mario's behavior still appears aberrant as very few, if any, of those around him engage in similar behavior (although, on some recent occasions, his close friends have accompanied him on his exploits).
The other most probable explanation for his behavior may be best understood by examining the specific context of his behavior. In other words, his violent, aggressive behavior seems to occur most frequently while in pursuit of rescuing others (most notably Peach and a woman named Pauline). As noted in the DSM, "the Conduct Disorder diagnosis should be applied only when the behavior in question is symptomatic of an underlying dysfunction within the individual and not simply a reaction to the immediate social context." Simply put, Mario may not warrant this diagnosis if his behavior can be explained by his immediate social context, i.e., responding to an extreme situation such as a kidnapping. This would be an adequate explanation for his behavior and consequently Mario would not warrant a Conduct Disorder diagnosis. However, Mario engages in certain behavior when there is apparently no morally justifiable need. For example, he has attacked others in the pursuit of money when this is unrelated to his rescue efforts (again, using physical force to obtain money - oddly only in the form of coins). He has approached men practicing football and apparently needlessly attacked them. He has pretended to be a medical doctor which has led to the vast expansion of multiple viruses. He has recently engaged in aberrant activities with his girlfriend, Peach, and thus rescuing her is not an adequate explanation for his behavior. Additionally, Mario does not engage in other interventions, such as conversation, before resorting to violence - that is, he will often confront others and assault them without saying anything.
PYROMANIA
The essential feature of Pyromania is the presence of multiple episodes of deliberate and purposeful fire setting.
Diagnostic Criteria:
A: Deliberate and purposeful fire setting on more than one occasion.
B: Tension or affective arousal before the act.
C: Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences).
D: Pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath.
E: The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgement (e.g., in dementia, Substance Intoxication).
F: The fire setting is not better accounted for by Conduct Disorder, a Manic Episode, or Antisocial Personality Disorder.
Analysis of Criteria
Mario has expelled many thousands of balls of fire from his hands across many years. These fires appear to be deliberately set and have the purpose of overcoming those whom he confronts (criteria A). There does not appear to be any evidence that Mario experiences tension of affective arousal before the act (criteria B). However, it should be noted that Mario typically elects to wear alternative clothing before expelling fire, and this may be a form of affective arousal. It is also unclear if Mario is unusually fascinated or otherwise attracted to fire (criteria C). Furthermore, it is unclear if he derives pleasure, gratification, or relief when setting fires - though it should be noted that he is typically smiling during the act. Mario appears to be involved with fire primarily to overcome what he determines to be obstacles, which includes for the purposes of monetary gain (oddly only in the form of coins) and to express hostility to others (criteria E). Considering the above considered information, it seems likely that Mario's fire setting may be better explained by another mental health disorder - possibly Conduct Disorder.
HALLUCINOGEN DEPENDENCE
The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.
Diagnostic Criteria:
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following occurring at any time in the same 12-month period:
(1) tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of the substance
(2) withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance
(b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
(3) the substance is often taken in larger amounts or over a longer period than was intended
(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use
(5) a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
(6) important social, occupational, or recreational activities are given up or reduced because of substance use
(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
Analysis of Criteria
Mario ingests a very large quantity of mushrooms. It is unclear if these mushrooms have psychoactive properties. For example, Mario appears to double in size when he eats some mushrooms, and it is unclear if this is a hallucinatory perception or an objective reality. There are currently no known fungi which would cause this reaction. Other mushrooms he ingests appear to give him the impression he can die and be resurrected. Such beliefs are indicative of delusions (beliefs that are held despite evidence to the contrary or that would be categorically dismissed by most people). His belief that he can survive beyond death appears to cause Mario to engage in risky behavior, such as jumping over pits filled with lava. They also appear to give him the illusion that he is larger than he is (again, this is somewhat unclear). These symptoms are typical of Hallucinogen Intoxication. Though he lacks some other symptoms (such as dilated pupils, blurred vision, and incoordination), his other symptoms are dramatic enough that it appears he is intoxicated.
Mario does not appear to experience tolerance or withdrawal (criteria 1 and 2). For example, one mushroom always appears to provide Mario with the same effect and he does not take additional mushrooms to prevent the effects from wearing off (criteria 3). However, hallucinogens such as mushrooms or LSD do not cause a physiological dependence (but may cause a psychological one) and so an absence of tolerance or withdrawal is to be expected. Mario does not appear to want to control this substance use, so criteria 4 can not be applied. He does appear to spend significant time in obtaining and ingesting mushrooms (criteria 5). He also continues to use the substance despite it's effects, but it is unclear if Mario has a knowledge of how the substance is impacting him (criteria 7).
It seems that Mario frequently ingests mushrooms that likely have psychoactive properties. However, Mario's behavior does not appear to meet criteria for Hallucinogen Dependence. It is possible that he may meet the less exacting criteria of Hallucinogen Abuse. It is worth noting that Mario appears to have a preoccupation with mushrooms generally, and not just their ingestion. For example, he frequently visits dwellings that look like mushrooms and even befriends others who have the physical appearance of mushrooms (a species known as "toadstools").
HALLUCINOGEN ABUSE
The essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.
Diagnostic Criteria:
A: A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance; substance related absences, suspensions, or expulsions from school; neglect of children or household)
(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
(3) recurrent substance-related legal problems
(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
B: The symptoms have never met the criteria for Substance Dependence for this class of substance
Analysis of Criteria
Mario is a plumber, but he rarely, if ever, engages in this profession. Instead, he engages in a variety of activities (as noted in the analysis section of Conduct Disorder) to obtain money. It is possible that his frequent ingestion of mushrooms is directly related to his truancy from work (criteria A1). He often uses mushrooms in situations that are hazardous, such as prior to jumping over pits filled with lava (criteria A2). He has not been arrested or otherwise disciplined for his substance use (criteria A3). It is unclear if his mushroom ingestion is directly responsible for any social or interpersonal problems - for example, his girlfriend Peach does not appear to have any problem with his behavior (criteria A4). As noted previously, Mario's symptoms have not met the criteria for Hallucinogen Dependence (criteria B).
Final Diagnosis:
Axis I: 312.89 Conduct Disorder, Severe, Unspecified onset
305.30 Hallucinogen Abuse
Axis II: V71.01 Adult antisocial behavior
Axis III: Deferred to medical personnel
Axis IV: Difficult work conditions, discord with neighbors
Axis V: GAF=68